title: Is myocardial stress perfusion MR-imaging suitable to predict the long term clinical outcome after revascularization?
abstract: BACKGROUND
  Aim of our study was to evaluate, whether myocardial ischemia or myocardial infarction (MI) depicted by myocardial stress perfusion MR imaging (SP CMR) can predict the clinical outcome in patients with coronary artery disease (CAD).
  
  
  METHODS
  220 patients were included. Myocardial perfusion was assessed at stress and at rest, using a 2D saturation recovery gradient echo sequence (SR GRE) and myocardial viability by late gadolinium enhancement magnetic resonance images (LGE CMR). MR-images were assessed in regard of presence and extent of MI and ischemia. Patients were monitored for major adverse cardiac events (MACE) (monitoring period: 5-7 years). MACE were correlated with the initial results of SP CMR.
  
  
  RESULTS
  Ischemia was found in 143 patients, MI in 107 patients. Number of MACE was in patients with normal SP CMR 0 (51 patients), with ischemia 21 (62 patients), with MI 14 (26 patients), with ischemia and MI 52 (81 patients). In all patients with severe MACE (MI, death) and in 63 of those with recurring symptoms LGE CMR revealed MI at baseline.
  
  
  CONCLUSIONS
  Negative SP CMR indicates low risk for MACE. In patients with stress induced ischemia, MACE might occur even after myocardial revascularization. The presence of MI proved by LGE CMR is associated with a significantly increased risk for MACE.
authors.affiliation: Eberhard Karls University Tuebingen, Department for Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany. bernhard.klumpp@med.uni-tuebingen.de
authors.forename: B
authors.initials: B
authors.lastname: Klumpp
authors.forename: A
authors.initials: A
authors.lastname: Seeger
authors.forename: C
authors.initials: C
authors.lastname: Bretschneider
authors.forename: S
authors.initials: S
authors.lastname: Mangold
authors.forename: P
authors.initials: P
authors.lastname: Krumm
authors.forename: S
authors.initials: S
authors.lastname: Miller
authors.forename: C D
authors.initials: CD
authors.lastname: Claussen
authors.forename: M P
authors.initials: MP
authors.lastname: Gawaz
authors.forename: A E
authors.initials: AE
authors.lastname: May
authors.forename: U
authors.initials: U
authors.lastname: Kramer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D009204:Myocardial Revascularization; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cardiac MRI; Coronary artery disease; Myocardial infarction; Myocardial perfusion; Prognosis after revascularization